Saturday, September 05, 2009

Is it worth doing IVF again ?

One of the most frustrating problems in infertility today is IVF failure - also called implantation failure. This refers to infertile patients who have undergone an IVF cycle and produced beautiful embryos - but the embryos have failed to implant for unexplained reasons.

Many patients who fail an IVF cycle often give up. Not only are they disappointed, they are also upset about the fact that their doctor does not usually give them a clear explanation for why the IVF cycle failed - or what they can do differently the next time, to improve their chances of success. While some stop for financial reasons, others come to the conclusion that they are destined to never have a baby; and admit defeat prematurely.

It's important to remember that while the reason for the IVF failure maybe a biological problem which cannot be corrected ( for example, a thin uterine lining which is not receptive), it is equally true that the reason for the failure maybe a medical variable ( for example, the wrong superovulation protocol; or a poor quality laboratory), which can be fixed in the next attempt.

Our pregnancy rates in patients who have failed IVF cycles elsewhere is very high, because we can transfer more embryos in difficult patients ( unlike fertility clinics in UK and Australia, where the number of embryos which can be transferred is limited by law). While transferring more embryos does increase the risk of high-order multiple pregnancies, this risk is negligible in difficult patients ( for example, the older women or women with previous failed IVF cycles). In our fertility clinic, we customise the number of embryos we transfer for each patient we treat, rather than just blindly follow a guideline ( which has been laid down for the general population, without considering each individual's specific problem).

The other common reason for a failed IVF cycle is a poor ovarian response, which means patients get few eggs and few embryos. For these patients, we offer the option of aggressive superovulation, with high doses of HMG, in order to help them grow more eggs, so we have more embryos to transfer.

Sometimes the reason for IVF failure is because the embryo transfer was technically difficult, because of cervical stenosis. This means that the transfer is often traumatic, and is associated with bleeding. For these patients, if their fallopian tubes are open, we prefer doing a fallopian tube transfer ( ZIFT ( ZIFT Video ) , zygote intrafallopian transfer) so that we can bypass the cervix and place the embryos directly in the fallopian tubes. This ensures a very high pregnancy rate.

Another group of patients who often do poorly in other IVF clinics are those who have PCOD. Because many doctors are so worried about the danger of OHSS ( ovarian hyperstimulation) in these patients, they often end up superovulating these patients badly, and retrieve few poor quality eggs, compromising the pregnancy rate. In our fertility clinic, we prevent OHSS by carefully aspirating each and every follicle at the time of egg retrieval , and flushing it repeatedly with a double-lumen needle, until it collapses completely. By removing the follicular cells which are responsible for producing VEGF and causing OHSS, we have been able to prevent OHSS in PCOD patients very successfully in our fertiliy clinic by using this novel technique.

If the first IVF cycle fails, it's always a good idea to get a second opinion, so you know what your options are, and what you can differently, in case you decide to try again.

3 comments:

HMG is much cheaper than Gonal-F - and is as effective ! I am a big believer in value for money and prefer products which are cost effective, rather than those which are "new" or which are marketed most aggressively !

i am already a fan! Since you are the very first doctor that I have talked to that was willing to still use HMG. I share your sentiments. IVF is very emotional and could cost the couple lot of money. As in our case with multiple IVF failures. Thank you